Background: Prolonged apneic time during tracheal intubation (TI) may increase the risk of oxygen desaturation in critically ill children. This study aimed to identify factors associated with long apneic times and examine the relationship between apneic duration and oxygen desaturation.
Methods: We conducted a prospective observational study of children <18 years undergoing oral TI in the pediatric intensive care unit and emergency department of a large academic children's hospital. Apneic time was measured and categorized as short or long using a 54-s cutoff. Desaturation was defined as SpO₂ <90% during the apneic period in children with baseline SpO₂ >90%.
Results: Among 204 TIs, the median apneic time was 54 s. Long apneic times were more common in infants than in younger children or older children. Apneic time did not differ by history of a difficult airway, provider type, laryngoscope type, or apneic oxygenation use. Oxygen desaturation rates were similar between long and short groups. There was no significant association between long apneic time and desaturation while apneic oxygenation significantly reduced desaturation risk.
Conclusions: Patient age was associated with long apneic times. While apneic time was not associated with desaturation, apneic oxygenation use was associated with lower occurrence of oxygen desaturation.
Impact: This study found that longer apneic times during pediatric tracheal intubation were not independently associated with oxygen desaturation after adjusting for patient age and apneic oxygenation use. Apneic oxygenation significantly reduced the risk of desaturation, supporting its routine use during tracheal intubation in critically ill children. These findings add evidence supporting age-specific airway strategies and highlight the importance of modifiable practices to improve the safety of pediatric airway management.
© 2026. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.